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A U DI T: Assistant Professor Dr. Hiwa Omer Ahmed
A U DI T: Assistant Professor Dr. Hiwa Omer Ahmed
Assistant professor
Dr. Hiwa Omer Ahmed
AUDIT
Isa process
Used by clinicians who seeks to
improve patient care
By comparing aspects of care
aspects
What to do
What to do
Ifthe care falls short of the criteria >
some changes in the way that care is
recognized is proposed.
at once
individual
team levels
institutional level
regional level
national level
Types
Cycle
quesions
Auditor address a series of questions
Traditional
`measures process
Depends on
compliance.
Surgical
Measures outcome 9 no placebo or
contr
How to do audit
1. prepare
Think broadly
Funding
Ownership
Skills
Time
teamwork
2. Selecting data
Think big
It must be measurable
Check guidelines
Systemic review
Process or outcome
Case mix; fixed and variables
3. Measuring the level of
performance
Routine data
Electronic data
Medical controls ?
Abstract data
legalities
4. Making improvements
Barriers to ch
Feedback
Discussion
Implementation methods
Clinical governance structure model
5. Sustaining improvements
Re-audit
Structural changes
Cultural changes; must society earns
AUDIT OF MANAGEMENT OF
HEAD TRAUMA
IN SLEMANI TEACHING
HOSPITAL 2001 – 2002
DR. HIWA OMER AHMED
MB.CHB. C.A.B.S
CONSULTANT SURGEON STH
PROF. ASSIST – COLLEGE OF
MEDICINE– UNIVERSITOF SLEMANI
SUMMARY:
Trauma remains the leading killer of
children and young adults, specially
head trauma injuries of different
types from fall from height (FFH) in
children to road traffic accident (RTA)
and quarrelling in adolescence and
young adults.
Every day many victims with head trauma
will arrive the Surgical Casualty
Department of STH, managed first by
house officer and senior house officers in
general Surgery.
As long as there is no uniform method
for management of these cases the author
is trying in this paper to audit the lines of
management for these victims in two
different surgical unites, each using away
of management different in many aspects.
Aiming that the conclusions may help in
promoting the practice in this field
INTRODUCTLON
0 - 9 25 38
10 + 19 14 15
20 - 29 9 14
30 - 39 13 6
40 - 49 7 3
50 - 59 6 2
60 - 69 2 -
70 - 79 4 2
Quarrelling 11 8
Table II: showing types of the trauma in both groups (A&B) of patients
Most of the injuries were mild (64patients in group-A), (52patients in group-B), as showed in table III,
which is clarifying the GCS of the patients on arrival.
No. of
Glasgow Coma
patients No. of patients
Severity Scale
Group Group -B
Scores
-A
15 60 43
Minor 14 4 4
13 - 5
12 6 7
11 1 12
Moderate
10 2 -
9 2 1
8 - 1
7 - 1
Severe
6 2 6
5 3 -
Table III. Showing GCS scoring in both groups (A&B) of patients
Most of the patients (63 patients in group-A, 56 patients in group –B)
remained in hospital for up to 47 hours as shown in table IV. .
0 - 23 hours 19 23
24 - 47 hours 44 31
3 - 9 days 14 23
13 days - 1
21 days 1 0
39 days 0 1
42 days 1 0
45 days 1 0
NO RECORD
4th day of admission 2
Rhinorrhea, Rhinorrhagia 4
4
Otorrhagia 3
1
Battle Sign 1
1
- 4 3
Rhinorrhia
+ - 1
- 1 2
Otorrhia
- - 1
Battle sign
+ 1 -
Not done
76 75
Normal 3 1
Done 4
Extradural
1 No. recording or
haematoma
paper
Table IIX: Showing results of the CT scans in patients form both groups (A, B).
These patients were managed in the casualty department and later in the surgical unite on follow up as showing in
table IX.
No. of
patients No. of patients
Management
Group- Group-B
A
Elevation of the head
80 60
of the patient
IVF 21 39
Craniotomy 2 No Record
Phenobarbiturate 10 7
Steroids - 61
Diuretic 1 4
Antibiotics 2 72
Analgesia - 63
Diazepam 1 4
Antiemetic - 3
Blood 2 6
Tracheostomy 2 -
Are not
recommended for
the treatment of
acute head injury.
DIURETICS:
In the emergency department should be
administered only with the consent of a
neurosurgeon or to gain time when neurosurgical
capabilities will be delayed and the patient’s
condition is deteriorating, because its beneficial
effect is transient, the drug can severely alter
serum electrolyte and osmolarity
Patients who are given Steroid, osmotic
diuretics, anticonvulsant & hyperosmolar feeding
are prone to develop hyperosmolar state, some
times leading to hyperglycemic nonketotic coma
(6).
when may be analyzed as deterioration of the
neurosurgical condition of the patient.
ANTIBIOTICS
Prophylactic antibiotics are not used
routinely because recent prospective
studies have failed to demonstrate
any benefit from their use (7), so
rarely indicated
ANALGESIA
Aspirin& other nonsteroidal
Analgesia all increase the risk of
upper GIT bleeding and peptic stress
ulcers, so it is better not to be used
routinely.
DIAZEPAM
Sedation reduces posturing &
combat activity, both of which
elevate ICP
ANTIEMETIC
When used, it has symptomatic
benefit but also may induces
occulogyric crises, which will be
misinterpreted for unwary personal.
There is a large difference between
the line of treatment in these two
groups, but the mortality was same
in both groups (A&B), one patient in
each group
CONCLUSION